Helping Yourself

Depressive disorders make you feel exhausted, worthless, helpless, and hopeless. Such negative thoughts and feelings make some people feel like giving up. You should realize that these negative views are part of depression, and typically do not accurately reflect your life situation. Negative thinking fades as treatment begins to take effect. Psychotherapy, especially cognitive psychotherapy, is specifically designed to change the negative thinking associated with depression.

In the meantime:

Do not set difficult goals for yourself, or take on additional responsibility. Break large tasks into small ones, set some priorities, and do what you can as you can. Do not expect too much from yourself too soon, as this will only increase your feelings of failure. Try to be with other people; it is usually better than being alone. Force yourself to participate in activities that may make you feel better. Try engaging in mild exercise, going to a movie, a ball-game, or participating in religious or social activities. Don't overdo it or get upset if your mood is not greatly improved right away. Feeling better takes time. Do not make major life decisions, such as changing jobs, getting married or divorced, without consulting others who know you well and who have a more objective view of your situation. In any case, it is advisable to postpone important decisions until your depression has lifted. Do not expect to snap out of your depression. People rarely do. Help yourself as much as you can, and do not blame yourself for not being up to par. Remember, do not accept your negative thinking. It is part of the depression and will disappear as your depression responds to treatment. Get help from a professional. No matter how much you want to beat it yourself, a psychologist can help you recover faster. Helping the Depressed Person

The most productive way to assist a depressed person, is to help him or her get appropriate treatment. This may involve encouraging the individual to stay with treatment until the symptoms begin to abate (several weeks), or to seek different treatment if no improvement occurs. On occasion, it may require making an appointment and accompanying the depressed person to appointments with the psychologist. It may also mean monitoring whether the depressed person is taking medication, if prescribed.

The second most important way to help is to offer emotional support. This involves understanding, patience, affection, and encouragement. Engage the depressed person in conversation and listen carefully. Do not disparage feelings expressed, but point out realities and offer hope. Do not ignore remarks about suicide. Always report them to the depressed person's psychologist.

Invite the depressed person for walks, outings, to the movies, and other activities. Be gently insistent if your invitation is refused. Encourage participation in some activities that once gave pleasure, such as hobbies, sports, religious or cultural activities, but do not push the depressed person to undertake too much too soon. The depressed person needs diversion and company, but too many demands can increase feelings of failure.

Do not accuse the depressed person of faking illness or of laziness, or expect him or her "to snap out of it." Eventually, with treatment, most depressed people do get better. Keep that in mind, and keep reassuring the depressed person that, with time and help, he or she will feel better.

Depressed People May Need Help to get Help

The very nature of depression can interfere with a person's ability to get help. Depression saps energy and self-esteem and makes a person feel tired, worthless, helpless, and hopeless. Therefore,

Seriously depressed people need encouragement from family and friends to seek treatment to ease their pain. Some people need even more help, becoming so depressed, they must be taken for treatment. Don't ignore suicidal thoughts, words or acts. Seek professional help immediately. Where to Get Help

A complete psychological diagnostic evaluation will help you decide the type of treatment that might be best for you. You can consult the National Directory of Psychologists on this website to locate a psychologist near your home, or contact the Psychological Association in your state to receive a referral. Contact information for all State Psychological Associations can also be found in the National Directory of Psychologists.

Cognitive Therapy

Psychological treatment of depression (psychotherapy) can assist the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems. At first glance, this may seem like several different therapies being used to treat depression. However, all of these interventions are used as part of a cognitive treatment approach. Some psychologists use the phrase, cognitive-behavioral therapy and others simply call this approach, cognitive therapy. In practice, both cognitive and behavioral techniques are used together. Once upon a time, behavior therapy did not pay any attention to cognitions, such as perceptions, evaluations or expectations. Behavior therapy only studied behavior that could be observed and measured. But, psychology is a science, studying human thoughts, emotions and behavior. Scientific research has found that perceptions, expectations, values, attitudes, personal evaluations of self and others, fears, desires, etc. are all human experiences that affect behavior. Also, our behavior, and the behavior of others, affects all of those cognitive experiences as well. Thus, cognitive and behavioral experiences are intertwined, and must be studied, changed or eliminated, as an interactive pair.

Psychotherapy

Psychological treatment of depression (psychotherapy) assists the depressed individual in several ways. First, supportive counseling helps ease the pain of depression, and addresses the feelings of hopelessness that accompany depression. Second, cognitive therapy changes the pessimistic ideas, unrealistic expectations, and overly critical self-evaluations that create depression and sustain it. Cognitive therapy helps the depressed person recognize which life problems are critical, and which are minor. It also helps him/her to develop positive life goals, and a more positive self-assessment. Third, problem solving therapy changes the areas of the person's life that are creating significant stress, and contributing to the depression. This may require behavioral therapy to develop better coping skills, or Interpersonal therapy, to assist in solving relationship problems. Unfortunately, many poorly trained counselors never move beyond providing supportive counseling. This alone will not eliminate the depression. As a result, the depression, and the therapy, continues indefinitely, with little improvement. Supportive counseling "feels" helpful, and as part of the overall treatment plan does help. But, unless the depressed person makes critical life changes, the depression will continue. These changes are both internal and external. Internal changes are usually needed in problem assessment, self-evaluation, the evaluation of others, and the expectations the depressed person has for himself/herself, others and about life. External changes may be needed in problem solving skills, stress management, communication skills, life managment skills, and the skills needed to develop and sustain relationships. The length of treatment will vary, according to the severity of the depression, and the number and kind of life problems that need to be addressed. Most people will begin to experience some relief with 6 to 10 sessions, and approximately 70-80% of those treated notice significant improvement within 20-30 sessions. Mild depression may be treated in less sessions, and more significant depression may require extended treatment. Treatment sessions are usually scheduled once per week, although they may be scheduled more frequently initially, or if the person is experiencing significant life crises.

Medical Depression Treatment: An Overview

More than 17 million Americans suffer from depression, a chronic disorder that affects every aspect of a sufferer's life: social and family connections, the ability to work productively and the ability to derive pleasure from life. With proper diagnosis and treatment, however, depression can be effectively treated in more than 80% of cases. Still, an estimated 89% of sufferers are not taking medication, and up to 15% of those hospitalized for depression commit suicide. In fact, suicide is the ninth leading cause of death in the United States, claiming 30,862 lives in 1996 alone. The number of cases in which it is difficult to determine cause of death leads investigators to believe even this number is a significant underestimation of suicides. There are several "classes" of medications available to treat depression. Medications are categorized by the way they interact with a variety of neurotransmitters. Even within a class, medications may affect individuals differently. Therefore, it is important for patients to work with their doctors to find the most beneficial treatment. Additionally, medication is usually prescribed in conjunction with counseling, psychotherapy or cognitive therapy, which help the patient learn techniques to better manage undesirable behavior patterns.

Drug Treatment

The presence of major depression and other depressive disorders is often an indication of a need for drug treatment. As the disease has been linked to abnormal levels of neurotransmitters - such as norepinephrine and serotonin-treatment of the disease aims to correct these imbalances. More than 20 antidepressant medications are now available. In recent years, research has been primarily focused on modulating serotonin in the brain. However, it has long been known that serotonin is not the only neurotransmitter involved in clinical depression. New research is looking at the role that norepinephrine plays in this disease, and new treatments targeting this neurotransmitter may provide patients with an alternative to current serotonin-focused therapies. Some antidepressants, including selective serotonin reuptake inhibitors (SSRIs) and the newer dual action (affecting both serotonin and norepinephrine) medications, are considered safer in terms of overdose toxicity and decreased side effects associated with the older tricyclic antidepressants (TCAs). However, it is nearly impossible to predetermine how any one patient will respond to any one treatment; physician-patient communication is critical in identifying the most appropriate therapy for the individual seeking medication.

The Drugs

TCAs, such as amitriptyline and imipramine, block both norepinephrine and serotonin reuptake. They are effective antidepressants, but they also affect many other receptor systems, which may cause a wide range of side effects, as well as toxicity in overdose. In spite of these drawbacks, they are still widely prescribed. However, they may not be as effective in practical use, as the high incidence of unwanted side effects means that patients may stop taking them. In addition to being a major factor in poor patient compliance, the side effect profile of the TCAs can lead healthcare professionals to be overly cautious and prescribe them at low, ineffective doses. Side effects of TCAs may include dry mouth and constipation. SSRIs, such as fluoxetine, paroxetine and sertraline, have minimal efficacy advantages over TCAs, and may even be less effective in some cases of severe depression. However, they are less toxic in overdose. The side effect profile for SSRIs is different than that of TCAs. Although side effects for SSRIs are generally fewer in number, they may be uncomfortable for patients (e.g., nausea, headache and sexual dysfunction). Serotonin and norepinephrine reuptake inhibitors (SNRIs) such as venlafaxine were, in theory, designed to combine the actions of both neurotransmitters. In practice, however, SNRIs' primary effect is on serotonin. This is because the norepinephrine effect appears only when the drug is taken in higher doses (with a concurrent risk and range of side effects). At standard doses, side effects are similar to those seen with SSRIs. Norepinephrine and specific serotonin antidepressants (NaSSAs), such as mirtazapine, do not work by inhibiting neurotransmitter reuptake, although the net effect is increasing brain levels of norepinephrine and serotonin. They are effective antidepressants and, because they block certain serotonin subreceptors, do not share the SSRI-type effects on sexual function. Commonly reported side effects include drowsiness, excess sedation, weight gain and dry mouth. Researchers are currently exploring a new class of antidepressants, selective norepinephrine reuptake inhibitors (NRIs), which block the reuptake of norepinephrine, suggesting that they may be effective antidepressants. Because they have a minimal effect on other receptor systems, the NRIs are expected to have fewer of the side effects that are associated with some other therapies. Possible side effects of NRIs include dizziness, headache, urinary retention, dry mouth, sweating and insomnia.

Treatment Success

Although the majority of depressed patients respond to treatment with antidepressants, successful treatment depends on a range of factors, including the choice of drug, its dosage, duration of treatment, individual patient response and patient compliance. Physician-patient communication is important in defining success and the expectations of both parties. Treatment may fail in up to 50% of patients because they stop taking their medication too soon. Reasons patients cite for giving up treatment prematurely include the fear of relying on the drug too much or becoming addicted, unacceptable side effects and feeling better (leading them to believe that continuing treatment is unnecessary). Effective medications with good side effect profiles are being developed as scientists learn more about the brain chemistry of a person with depression. As the antidepressants currently available have varying results and side effects, a particular person's response is not predictable, since individuals may respond quite differently to the same medication. It is important to remember that finding the right medication strategy can take time.